R590. Insurance, Administration.R590-282. Pharmacy Benefit Managers.
R590-282-1. Authority.
This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-46-202, and 31A-46-301.
R590-282-2. Purpose and Scope.
(1) The purpose of this rule is to:
(a) define terms;
(b) provide licensing requirements; and
(c) establish the format for reporting data.
(2) This rule applies to a pharmacy benefit manager operating in Utah on or after July 1, 2019.
R590-282-3. Licensing.
(1)(a) To obtain or renew a pharmacy benefit manager license, an applicant shall:
(i) submit the Utah Insurance Department Pharmacy Benefit Manager Application and the required attachments; and
(ii) pay the fee in an amount annually established by the Utah Legislature under Section 63J-1-504.
(b) The Utah Insurance Department Pharmacy Benefit Manager Application is available on the Department's website, https://insurance.utah.gov.
(2)(a) The licensing period begins on April 1 of each year and ends on March 31 of the following year.
(b) A license for which a renewal license application is not received by the commissioner before April 1 is considered expired.
(4) Any material changes to the information submitted in an application shall be reported to the commissioner no later than 30 days after the day on which the information changes.
R590-282-5. Reporting Requirements.
(1)(a) Beginning on April 1, 2020, and each year thereafter, a pharmacy benefit manager shall submit the Utah Pharmacy Benefit Manager Report.
(b) The Utah Pharmacy Benefit Manager Report and its instructions are available on the Department's website, https://insurance.utah.gov.
(2)(a) At least 30 days prior to publishing any data derived from the Utah Pharmacy Benefit Manager Report, the commissioner shall email to each pharmacy benefit manager submitting data under Subsection (1), a general description of the data to be published.
(b)(i) A pharmacy benefit manager may respond to the email by submitting the information specified in Subsection 31A-46-301(3)(c)(ii) to the Health Research folder of the Department's secure file upload website, https://forms.uid.utah.gov/fileUploads/.
(ii) A response must be received within 30 days of the date of the email described in Subsection (2)(a).
R590-282-6. Severability.
If any provision of this rule, Rule R590-282, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.
KEY: insurance, pharmacy benefit manager
Date of Last Change: September 10, 2024
Notice of Continuation: December 20, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201(3); 31A-46-301(3)(c)(ii); 31A-46-202(1)(a)
